1 ECRS Web Enhancements for Prescription Drug Assistance Requests

2 ECRS Web Used to notify COBC regarding New Other Health Insurance (OHI) coverage, or Changes to existing OHI coverage

3 ECRS Web OHI information must be communicated promptly Missing, inaccurate or invalid OHI records may result in: Plans not paying a claim correctly Incorrect calculation of a beneficiary’s TrOOP calculation

4 ECRS Web Did not originally include a transaction to request modifications to drug coverage To modify drug coverage, users submitted the CWF Assistance Request with: Dummy MSP values to pass front-end MSP edits Comments to identify the correct Drug Occurrence record to be updated/deleted and the reason for the request

5 Prescription Drug Assistance Request Used to update/delete existing Drug Occurrences Provides easier, user-friendly interface Updates are entered into new data-entry Web pages

6 Prescription Drug Assistance Request Eliminates use of CWF Assistance Request for Drug Occurrences Including the need to submit dummy hospital and medical coverage information

7 ECRS Web Enhancements Use the PDR to submit all Drug Occurrence update/delete requests Majority of requests will be automatically processed, and Contractor may receive a response within hours Do not use the CWF Assistance Request to submit Drug Occurrence update/delete requests Request will not be automatically processed Response time will be longer

8 New Actions for Drug Occurrence Records Added to facilitate all commonly requested updates/special processing ActionAction Description APAdd Policy Number/Group Number BNDevelop for Rx BIN CXChange Rx Values (BIN, Group, PCN) GRDevelop for, Group Number PCUpdate Rx Person Code PNDevelop for/add PCN

9 Automated Processing of Certain Actions PDRs submitted with the following Actions will automatically process to speed response time PDR cannot have any reject errors Key fields must match an existing Drug Occurrence ActionAction Description APAdd Policy Number/Group Number CXChange Rx Values (BIN, Group, PCN) DODelete Occurrence TDAdd Termination Date

10 Submitting the PDR Verify that the Drug Occurrence is not marked for deletion Delete Indicator (on MARx report) does not = ‘Y’ When a record has been deleted Update requests are not feasible If the record was deleted in error, it must be added back using the Prescription Drug Inquiry transaction Check ECRS Web to see if transaction was submitted

11 Submitting the PDR Identify correct Drug Occurrence that requires update/delete by Ensuring data submitted in key fields on PDR match the Drug Occurrence stored on Medicare’s files A Medicare beneficiary may have multiple Drug Occurrences Carefully review daily/monthly MARx files to identify correct Drug Occurrence to be updated/deleted

12 Submitting the PDR Primary Drug Occurrence (Record Type = ‘PRI’) Submit data that exactly matches the existing primary Drug Occurrence for the following fields: Primary Drug Occurrence Key Fields Field NameECRS Web PageFlat File Position HICNAction Requested Patient RelationshipAction Requested MSP TypeAction Requested163 Effective DateAction Requested Originating ContractorAction Requested

13 Submitting the PDR Supplemental Drug Occurrence (Record Type = ‘SUP’) Submit data that exactly matches the existing supplemental Drug Occurrence for the following fields: Supplemental Drug Occurrence Key Fields Field NameECRS Web PageFlat File Position HICNAction Requested Person CodeAction Requested Supplemental TypeInsurance Information562 Effective DateAction Requested Originating ContractorAction Requested

14 Submitting the PDR Include all required data elements to: Prevent request from being rejected Assist COBC Analysts in identifying the correct record Required data fields are denoted by asterisks: However, additional data may be required depending on the value(s) submitted in certain fields

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16 ECRS Web Enhancements MSP Occurrence termination/delete requests will be automatically applied to the linked Drug Occurrence CWF Assistance Request with Action ‘TD’ or ‘DO’ automatically applied to the linked Drug Occurrence as long as there are no reject errors Prescription Drug Assistance Request will not have to be submitted if the linked MSP Occurrence was deleted/terminated

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18 ECRS Web Enhancements The following Web pages will be displayed when creating a Prescription Drug Assistance Request Action Requested Informant Information Insurance Information Employment Information Additional Information Comments/Remarks Summary Web pages are similar to those used for CWF Assistance Requests

19 Prescription Drug Assistance Request Users must have proper authorization to use ECRS Web Requires an IACS User ID and Password Complete self-registration process at: For more information on obtaining access to ECRS Web, please see Chapter 5, Section at the following link:

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38 Primary Drug Occurrence Update Example Existing Working Aged Primary Drug Occurrence HICN – A Effective Date – No Termination Date Health Plan providing this coverage is notified of the following inaccuracies: Group Number MVP123 is missing PCN is incorrect Health Plan must submit a Prescription Drug Assistance Request

39 Primary Drug Occurrence Update Example Before submitting the PDR Ensure that the record is not marked for deletion Ensure data in key fields* match Field NameValue *HICN A (the Member’s HICN) *Patient Relationship Code01 (Patient is policy holder) *MSP TypeA – Working Aged *Effective Date *Originating Contractor11110 ActionCX (Change Rx Values (BIN, Group, PCN)) AP (Add Policy Number/Group Number) Group NumberMVP123 PCNA CommentsAs Applicable

40 Supplemental Drug Occurrence Update Example Existing Supplemental Drug Occurrence HICN – A Effective Date – No Termination Date Member notifies their Drug Plan Sponsor They have opted out of this plan as of January 5, 2012 Drug Plan Sponsor must submit a Prescription Drug Assistance Request

41 Field NameValue *HICN A (the Member’s HICN) *Person Code001 *Supplemental TypeL - Supplemental *Effective Date *Originating Contractor11110 ActionTD (Add Termination Date) Termination Date Supplemental Drug Occurrence Update Example Before submitting the PDR Ensure that the record is not marked for deletion Ensure data in key fields* match

42 Viewing, Updating or Deleting a PDR ECRS Web allows users to view, update or delete a transaction View a transaction to: Verify if a submitted PDR was successful (by viewing the response) Determine if a PDR was previously submitted for the desired change PDR can only be updated/deleted: By a user with the same contractor number as the originating contractor number When the transaction is in ‘NW’ (New) Status

43 Status and Reason Used to identify the current state of the transaction Prescription Drug Assistance Request is automatically stored on COBC’s system Batch process reads transactions and processes them Updated as transaction moves through the system

44 Defines the current state of the record in the COBC system Status Description CM PDR has been completed DE PDR has been deleted IPIn process, being editing by the COBC NWNew, not yet read by the COBC HD Hold, individual not yet a Medicare beneficiary

45 Reason Explains why transaction is in a particular status Reason Codes Reason Description Not yet read by COBC, used with NW Status Being processed by COBC, used with IP Status Under development by COBC, used with IP Status Prescription Drug Information sent to MBD, used with CM Status

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56 File Submissions Flat file submission process will include a new PDR File Type for Prescription Drug Assistance Requests Will only include the data needed to process a PDR

57 File Submission Methods Uploaded via ECRS Web Transmitted external to the ECRS Web Connect:Direct, or SFTP

58 Connect:Direct Requires FTP connection with a certified Verizon reseller Most costly option

59 Connect:Direct Input File Naming Convention Destination dataset name: PCOB.BA.NDM.ECRS.INPUT(+1) NodeDescription 1stProduction Files: PCOB Test Files: TCOB 2 nd BA 3 rd NDM 4 th ECRS 5 th INPUT(+1)

60 Connect:Direct Input File Naming Convention Indicates if record was accepted, rejected, or updated Most files returned within 24 to 48 hours Naming convention: PCOB.BA.ECRS.CCCCC.RESP.PS NodeDescription 1stProduction Files: PCOB Test Files: TCOB 2 nd BA 3 rd ECRS 4 th Plan Number (e.g., H####). 5 th RESP 6 th PS

61 SFTP New SFTP users must set up a GENTRAN mailbox Call the MAPD Help Desk at , or Send an to: Current SFTP users may use their existing GENTRAN mailbox Will use the same CMS SFTP Mailbox (organization number) and IACS User ID for ECRS

62 NodeDescription 1stIACS User ID 2 nd CMS RACF USERID or “NONE” 3 rd ECRS 4 th D for Daily, W for Weekly, M for monthly, Q for quarterly, Y for Yearly, A for Ad Hoc 5 th Plan Number 6 th FUTURE 7 th T for test or P for production 8 th If file compressed/zipped SFTP – Input File Naming Convention Naming convention: GUID.RACFID.APPID.X.UNIQUEID.FUTURE.W.ZIP

63 NodeDescription 1stProduction Files: PCOB Test Files: TCOB 2 nd BA 3 rd ECRS 4 th Plan Number (e.g., H####). 5 th RESPONSE 6 th Date/time stamp SFTP – Response File Naming Convention Indicates if record was accepted, rejected, or updated Most files returned within 24 to 48 hours Naming convention: PCOB.BA.ECRS.CCCCC.RESPONSE.SSSSSSS

64 ECRS Web Most effective method Allows information to be input daily, one record at a time or as a flat file Users can view the entered information and see the action taken by the COBC

65 Next Steps Curriculum of CBTs to assist you in Using ECRS Web Understanding the fundamentals of MSP We strongly encourage you to complete all appropriate CBTs offered

66 Next Steps To register for the curriculum, send an to Company name Company description Name Phone number (formatted ###-###-####) address notification will be sent to each registered individual

67 Questions